Dr Norouzi was found to have engaged in ‘inappropriate practice’ by a Professional Services Review (PSR) Committee (as defined under the Health Insurance Act 1973) because he had been found to have used MBS items for afterhours services which had not been rendered in compliance with Medicare’s requirements. In that regard, the criteria for MBS item 597 and 599 (that the patient’s conditions required urgent medical treatment) was not met.
Subsequent to the PSR Committee hearing, the matter moved to the Determining Authority to decide upon the relevant sanction to be imposed.
The Determining Authority decided, inter alia, to require Dr Norouzi to repay the Medicare benefits for MBS items 597 and 599 which were found to have been inappropriately rendered, less the amount that Dr Norouzi had already voluntarily repaid.
Dr Norouzi sought judicial review of the PSR Committee and the Determining Authority decisions.
The Court held that the application in respect of the PSR Committee was made out of time and no extension of time was allowed. Therefore the application for judicial review of the PSR Committee decision was dismissed.
In respect of the decision by the Determining Authority, Dr Norouzi argued that he should only be required to repay the difference between the urgent MBS item incorrectly ascribed to the service and non-urgent MBS item which would have been applicable to the service. This argument was advanced because the PSR Committee had found that a service was in fact performed.
The Court accepted Dr Norouzi’s argument and held that ‘the flaw in the decision in relation to repayment is misapprehension of an ability to require part payment and that engaging with the submissions made to it did not require any departure from the committee’s findings, only intellectual engagement with them and the MBS.’
The Court did not quash the whole of the Determining Authority’s decision but only the direction in respect of the repayment. The matter was remitted back to the Determining Authority for reconsideration according to law.
This article was written by Scott Chapman, Partner and Megan Priestley, Special Counsel.
